PUBLIC RECORD OFFICE
19
Reference :-
C.O.885
19 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
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hospitals, where they already conform to it, should not be imposed upon them; I understand that in Mauritius and British Guiana this has been secured without any great difficulty, and it should not be insuperable here. I think the "non possumus" attitude has been too readily accepted as an answer to this recommenda tion advanced here more than once, but almost invariably set aside because alleged to be impossible in operation owing to caste and other East Indian prejudices and habits. I regard the above as the most essential and the most radical procedure to exterminate the disease amongst indentured immigrants, who constitute at least one of its most fertile sources here; the Honourable Protector of Immigrants has already pointed out that if the sub-sections of Section 90, or Sub-section 5 of Section 130 of the Immigration Ordinance No. 161 do not constitute this particular offence to be a nuisance, or attach penalties to indentured immigrants who wilfully con- taminate a plantation indiscriminately, then a small verbal addition in the following terms to Sub-section 4 of Section 90 or any other part of the plantation except in the place therefore provided" would furnish sufficient powers to deal effectually with offenders.
I suggest also that future allotments of immigrants to estates should be made conditional upon the proprietors agreeing to provide beforehand suitable and sufficient latrine accommodation to the satisfaction of the medical authorities, at the barracks, at the estates hospitals, and also in the fields where the labourer spends about half of his indentured life.
Attention must be devoted also to the infected native labourer who, with the indentured immigrant, is a potent factor in the dissemination of the disease, and possibly one still more difficult of control. It is a counsel of perfection to advise that every peasant's hut should have its privy adjacent, but efforts in the direction of this desirable result might be attempted, and Sanitary Inspectors might be induced to encourage the provision and use of such necessary adjuncts of civilisation, and to devote more attention at the same time to their supervision of existing accommoda- tions.
It is not too much to expect that public conveniences should be provided in populous centres and maintained under efficient control if for no other purpose than to serve as object lessons to the class most likely to use them; and also that in the new Public Health Ordinance now drafting at the hands of the Special Committee, there should be found sections prohibiting the occupation of any new premises as a residence until it is furnished with sanitary accommodation to the satisfaction of the Medical Officer of Health. Next in order of my outline scheme comes
3. I have ascertained that a majority of estates proprietors is willing to provide at their hospitals small microscopes and other simple apparatus required there for accuracy of diagnosis, and at my instance a supply for distribution to them has been ordered through the Crown Agents.
3. Efforts should be set on foot and encouraged in every possible way to instruct the labouring class in the nature of the disease-the simplicity of the pro- cedure recommended to control its extension, the success of which so largely rests with themselves. The small handbook on Elementary Hygiene in the Tropics approved and shortly to be placed in the hands of Government school teachers, is now under revision prior to the issue of a second edition, and a section in it on ankylostomiasis will be elaborated and made easily intelligible. Every public school house throughout the island should be a centre for the active dissemination of hygienic precept, and should provide in its sanitary accommodation an object lesson to its pupils, valuable just to the extent that it is made so by the schoolmaster and Inspector. There was recently brought to my notice the case of a Government school, having a daily attendance of 70 pupils, where the privy accommodation was filthy, and the School Master complacently admitted it had not been cleansed since he had charge-during a period of three years! In districts known to be infected, the distribution of leaflets briefly and simply describing the disease, its symptoms and prophylaxis might be useful.
4. At first I think the treatment of individual cases of the disease must be confined to those that present themselves to medical officers in the ordinary course of practice; routine methods of approved efficacy might be suggested for general adoption, and as yet I do not recommend special dispensaries or hospitals, which would necessarily involve increase of the medical and subordinate staff.
5. Similarly the treatment en masse can be effectively managed at present only on estates and amongst their regular labouring populations. The preventive value of tar and of some form of foot-wear will again be brought to the notice of estates
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proprietors. When the symptoms, &c., of the disease become more generally recognised, and if statistical evidence should indicate its wide extension then special measures on a larger scale might be desirable; but if the recommendations under 1, 2, and 3 prove capable of application and effectual, as I think may be anticipated from them, a scheme for general treatment en masse should not be required.
6. I hope, in the future, to obtain from medical officers regular monthly returns showing accurately the distribution prevalence and the progress of the disease in their respective districts, and this information should later afford valuable indica- tions as to the need of more expansive measures of control.
In conjunction with the above special methods of prophylaxis, other precautions contributing indirectly to the same object should not be neglected. On many estates the water supply is a possible source of infection, and is capable of improvement in regard to Loth purity and better storage accommodation. Barrack sites and sur- rounding areas should be kept clean, free from low undergrowth and well drained, and an occasional upturning of the soil there would destroy ova deposited in it despite of vigilance and regulations to the contrary. The avoidance of overwork and consequent fatigue, of prolonged unnecessary exposure to damp or to great heat, ensuring that sufficient diet and clothing are habitual, and, in short, all treatment that helps to maintain the labourer in good health and condition will render him less susceptible to the injurious effects produced by the parasite, and better fitted Depressing to undergo and benefit from the treatment necessary for his cure. physical or moral influences act independently of or together with the presence of ankylostoma in producing anæmia."
瑞喜
Although the presence of the disease in Trinidad, so far as I can ascertain, appears to be largely confined to the sugar-producing districts and estates, I think the possibility of its development on cocoa and banana cultivations, on some of which it is known already to exist, should not be disregarded. All the essential requisites for the propagation of the parasite in its larval stage are present in cocoa estates and banana fields to a degree even more favourable than on sugar estates, where plough. ing operations are frequent in the ordinary routine of cultivation, and destroy the larvæ present on its surface by free exposure of the soil to direct sunlight, heat, and drying influences. In past years, and thus accounting for their present relatively heavy infection, sugar estates have practically enjoyed an unenviable monopoly of the imported infecting agent in the persons of indentured immigrants, but recently. and in annually-increasing numbers, these are now being distributed to cocoa estates, which are thus provided with the only factor the absence of which has hitherto secured to them their immunity from the disease. Cocoa estates proprietors who employ indentured labour would be wise to observe in advance on their plantations the preventive measures recommended for excluding and exterminating the disease, and thus to protect their employees from its incidence and themselves from diminished labour supply that will surely follow upon the uncontrolled extension of
H. L. CLARE,
the disease.
5th October, 1908.
Surgeon-General.
RETURN of Cases of Ankylostomiasis treated at Medical Institutions and Estates' Hospitals during the years 1904-05, 1905-06, 1906-07, and 1907-08.
1901-1905 1903-1906 1906-1907
1907-1908
Total
Period.
Surgeon-General's Office,
5th October, 1908.
Estates' Hospitals.
Medical Institutions.
Total.
:
Sugar.
Cocos.
216
158
17
391
356
711
21
1.091
427
107
5
539
430
114
7
551
1,429
1,000
53
2,572
H. L. C.,
Surgeon-General.
32655
A